Indications for office radiographs

Radiology is an essential part of the family physician's office practice. Like most diagnostic tools, radiographs can provide valuable information, but they also have the potential to be abused. One of the first tasks in ensuring optimal use of any procedure is to establish criteria for proper patient selection. This article is a review of general and specific indications for office radiographs on both symptomatic and asymptomatic patients based on published expert consensus and studies that have examined indications for radiographs using clinical criteria. For symptomatic patients, indications are discussed for the following radiographs: extremities (traumatic and nontraumatic), skull, abdomen, chest, orbits, sinuses, facial bones, and spine. Indications for asymptomatic patients are discussed with specific attention to lumbosacral spine and chest radiographs. When appropriate indications are followed, the physician can avoid the problem of overuse and its consequent radiation and economic burdens, as well as the problem of underuse with its risk of incomplete evaluation.